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Stewardship / Resistance Scan for Aug 23, 2021

Stewardship / Resistance Scan for Aug 23, 2021

Procalcitonin testing may reduce antibiotics for COVID pneumonia

Early use of a procalcitonin-guided algorithm in non-critically ill patients hospitalized with COVID-19 pneumonia reduced antimicrobial use with no adverse effects, researchers reported last week in JAC-Antimicrobial Resistance.

In a retrospective, single-site cohort study, researchers from the United Kingdom compared outcomes in two groups of patients who had confirmed or suspected COVID-19 pneumonia and were receiving antimicrobial therapy. One group had levels of procalcitonin—a biomarker for bacterial infection—measured within 72 hours of receiving antimicrobials; the other had no procalcitonin testing. The algorithm advised that procalcitonin levels of 0.25 nanograms per liter or lower were negatively predictive of a bacterial co-infection, and that antimicrobial therapy could be stopped.

The primary outcomes were duration of antimicrobial exposure and per-patient antimicrobial consumption. Secondary measures included a composite outcome of death, admission to the intensive care unit, and hospital readmission.

A total of 259 patients were included in the final analysis, 117 of whom had procalcitonin levels measured (45.2%). The patients in the procalcitonin group had lower antimicrobial exposure (mean duration, 4.4 vs 5.5 days) and consumption (mean, (6.8 vs 8.4 defined daily doses) than those who did not have procalcitonin levels measured. There were no differences in the composite safety outcome in both the unadjusted and adjusted analyses. 

“We found a moderate reduction in antimicrobial duration and consumption in patients where procalcitonin was measured within 72 h of starting antimicrobials, with no differences in adverse outcomes or length of stay,” the authors wrote. “Our results suggest that it is safe to use a procalcitonin-based protocol in the antimicrobial decision-making process.”

The authors add that the impact of higher or lower procalcitonin thresholds should be further investigated in larger prospective studies.
Aug 20 JAC-Antimicrob Resist study


Report highlights need, market potential for new antibiotics

A new report from the Global Antimicrobial Resistance Research and Development (AMR R&D) Hub highlights how the financial challenges of the antibiotic market will continue to hamper the development of technologies considered critical to address rising drug resistance.

To further understand how the current market for AMR-related health technologies will impact development of therapeutics and diagnostics, the Global AMR R&D Hub initiated a study to determine the priority targets and the greatest patient need for new AMR technologies over the next 20 years. The study concluded that cases of multidrug-resistant bloodstream infection (MDR BSI) will rise to 5.5 million by 2040, cases of MDR pneumonia will rise to 2.8 million, and that two new antibiotics will be needed to effectively treat these infections.

But under current market conditions, if these two antibiotics were approved in 2025, they would generate less than $200 million in sales revenue ($184 million for BSI and $127 million for pneumonia) at their market peak in 2036.

“These estimates are broadly in line with similar estimates previously carried out and confirm a now solid body of evidence—from studies and anecdotally—that antibiotic markets are unattractive investments for private companies and investors, both in absolute terms and relative to other therapeutic areas,” the report states. “This situation, combined with the long development time of new drugs, signals that action is warranted increasingly urgently.”

In addition, the forecast indicates a worsening access gap, in which many patients in low- and middle-income countries—where the need for new therapeutics is growing most rapidly—won’t have to access to these antibiotics.

The study also estimated that sales revenues for the two priority diagnostic tests identified were similarly modest, around $400 million by 2040.

In light of the findings, the report recommends national-level reform of antibiotic pricing and reimbursement, along with additional pull incentives to make antibiotic development more attractive to pharmaceutical companies and private investors.
Aug 19 Global AMR R&D Hub report

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